24 August 2017

1. Sustainable Development Goals:
The 2030 Agenda for Sustainable Development and its 17 Sustainable Development
Goals (SDGs) were adopted in 2015 by all Member States of the United Nations.
Health and well-being for all at all ages is a goal in itself (Goal 3), but it
also affects and contributes to other SDGs. In addition, progress towards other
SDGs can directly and indirectly benefit health and well-being. Health 2020,
the policy framework for the WHO European Region, incorporates approaches and
priorities common to the 2030 Agenda and provides a stepping stone towards
achieving the SDGs in the Region.

The Australian Longitudinal
Study on Women’s Health (ALSWH) is a longitudinal survey of over 58,000 women
in three cohorts who were aged 18-23, 45-50 and 70-75 when surveys began in
1996: http://www.alswh.org.au/

23 August 2016

I need your help to fill out this short survey, so that I
can advocate to make Tasmania a better place for you! The results of the survey
as well as two meetings already held with the Commissioner for Children and
Young Peoples Advisory Council will be published in a Report to be released
later this year. https://www.surveymonkey.com/r/M9CMCP6

2. Just announced! The New
Parliament: Challenges Australia Can’t Ignore

We are delighted to announce a special panel event in
October featuring Michelle Grattan
AO (Chief Political Correspondent at The Conversation), Dr Cassandra Goldie (CEO, Australian Council of Social Service) and
Professor Ian Harper (Deloitte
Access Economics and Reserve Bank Board Member). Mark your diaries now for
6.00pm on Tuesday 25 October in the
Stanley Burbury Theatre, Sandy Bay Campus. We will be serving refreshments
from 5.30pm. Early registrations can be emailed to Louise.Grimmer@utas.edu.au. This
is a free event and open to members of the public as well as University staff
and students. http://www.utas.edu.au/social-change/home

Professor Sir Michael Marmot, President of the World Medical
Association, has been a leading researcher on health inequality issues for more
than four decades. He has played a central role in research projects studying
health equity and bringing research evidence to bear on policy and practice.
His many achievements include chairing the Commission on Social Determinants of
Health for the World Health Organization in 2005 which produced the
influential Closing the Gap in a Generation report in 2008. Its central
conclusion was social injustice is killing on a grand scale.

4. What will it take for
Tasmania to have Australia’s healthiest population by 2025?

When you think about your household’s income, do you feel
rich, poor, or just average? Most of us have no idea – or the wrong idea – of
how we compare with the rest of the population. But here, in 10 clicks, you can
find out how many households are better or worse off than yours, and see how
your ideal world compares. http://www.compareyourincome.org/index.php

15 July 2016

The Lancet is publishing its first Series on transgender
health. Transgender people live in all countries, but their acceptance by
communities and freedom to live with their chosen gender identity or expression
varies according to culture and society. Read more: http://www.thelancet.com/series/transgender-health.

2. Global Nutrition Report 2016: Rates of obesity and
overweight are rising in every region of the world and in nearly every country
according to the 2016 Global Nutrition Report. The independent report reveals
insufficient progress in the fight against all forms of malnutrition; for
example, almost all countries are off course on efforts to reduce anemia in
women and to prevent further increase in diabetes. Read more: http://globalnutritionreport.org/

3. The Social Determinants of NCDs - Youtube Video
Walk the streets of Copenhagen, Denmark, as Dr Alessandro Demaio explains the Social
Determinants of NCDs and Global Health. Click here to watch the video.

4. You can Create Change: In October 2015, the
Sudbury & District Health Unit (SDHU) launched a campaign called You Can
Create Change. It is part of the SDHU’s health equity communications and social
marketing activities, which aim to shift the conversation about health equity
in our communities, and, more importantly, to encourage community members to
take action to address health inequities. As part of this campaign we have
developed a video. This video highlights the notion that everyone can create
change in their community.

The video, along with information about the campaign, can be
found online by visiting www.sdhu.com/change

5. The challenge of false beliefs∗ Understanding and
countering misperceptions in politics and health care:

Misperceptions about politics and health can undermine
public debate and distort people’s choices and behaviour. Why do people hold
these false or unsupported beliefs and why is it so difficult to change their
minds? An emerging literature examines the difficulty of correcting false or
unsupported beliefs and the reasons for this resistance, but relatively little
is known about the sources of misperceptions, the psychology of misperception
belief, or how to most effectively counter these false claims. In addition,
most studies focus on the mass public’s beliefs in well-known misperceptions;
the mechanisms by which false beliefs become politicized, disseminated, and
integrated into individual belief systems and the role of elites and the media
in that process are less well understood. Read more: https://www.isr.umich.edu/cps/events/Nyhan_20160613.pdf.

6. How to improve collaboration between the public health
sector and other policy sectors to reduce health inequalities?A
study in sixteen municipalities in the Netherlands. The causes of
health inequalities are complex. For the reduction of health inequalities,
intersectoral collaboration between the public health sector and both social
policy sectors (e.g. youth affairs, education) and physical policy sectors
(e.g. housing, spatial planning) is essential, but in local practice difficult
to realize. The aim of this study was to examine the collaboration between the
sectors in question more closely and to identify opportunities for improvement.
The study found that the policy workers of social sectors were more involved in
the public health network and more frequently supported the objectives in the
field of health inequality reduction. Both social policy sectors and physical
policy sectors used policies and activities to reduce health inequalities. More
is done to influence the determinants of health inequality through policies
aimed at lifestyle and social setting than through policies aimed at
socioeconomic factors and the physical environment. Where the physical policy
sectors are involved in the public health network, the collaboration follows a
very similar pattern as with the social policy sectors. All sectors recognise
the importance of good relationships, positive experiences, a common interest
in working together and coordinated mechanisms. This study shows that there is
scope for improving collaboration in the field of health inequality reduction
between the public health sector and both social policy sectors and physical
policy sectors. Ways in which improvement could be realised include involving
physical policy sectors in the network, pursuing widely supported policy goals,
making balanced efforts to influence determinants of health inequalities, and
increasing the emphasis on a programmatic approach. Read more: click here.

7. Beyond Individualised Approaches to Diabetes Type 2

Explanations for type 2 diabetes are broadened beyond the
individual body and ‘bad lifestyles’ to include major institutions, the social
and material contexts of food and eating, and employment. Precarious
employment, a social determinant of health, encourages changes to food
practices, lowers working conditions, worsens health, can bring poverty and
increases shift work, a causal risk factor for diabetes. Scientists have played
a part in revolutionising foods and technologies which minimise labour and
movement. There are excess additives in processed food. Genetic explanations
for the higher rates of diabetes in First Nations peoples give way to social
explanations: colonial history, British/Euro-American cuisine, food insecurity,
trauma and social conditions resulting in chronic stress. Self-management
education takes a ‘nutritionist’ approach towards food and eating and tends to
minimise the social context and skills of those with the condition particularly
women workers in poorer social groups who have higher rates of diabetes (T2DM).
Read more: http://onlinelibrary.wiley.com/doi/10.1111/soc4.12369/full

Professor Phil Hanlon from the University of Glasgow
discusses such seemingly intractable problems as; obesity, overwhelming
involvement in various 'addictions', loss of wellbeing and inequalities as
emergent products of our late modern culture and social structures. He argues
that these problems will not improve until there is a radical transformation of
our whole society and the culture that has created it. Watch here:

28 April 2016

Public Forum - A
fair go for all: Addressing social and health inequities in Australia and
internationally - 12 May 2016. The Forum will focus on what works and why in
policy areas including: Indigenous affairs, urban environments, social
protection/paid parental leave and health systems. The forum will start
with a panel discussion entitled "How equitable is the Federal 2016
budget?” hosted by Paul Barclay, host of Big Ideas on ABC Radio National. This
discussion will be broadcast on the Big Ideas radio program. For more
information: http://www.anu.edu.au/events/a-fair-go-for-all-addressing-social-and-health-inequities-in-australia-and-internationally-0

UNICEF report -
'Fairness for Children' - released 14 April 2016. This Report Card presents an overview of inequalities in child well-being in 41
countries of the European Union (EU) and the Organisation for Economic
Co-operation and Development (OECD). It focuses on ‘bottom-end inequality’ –
the gap between children at the bottom and those in the middle – and addresses
the question ‘how far behind are children being allowed to fall?’ in income,
education, health and life satisfaction. Visit: https://www.unicef-irc.org/publications/830/?utm_source=m2news-newsletter&utm_medium=email&utm_content=html&utm_ca.

Abstract:
This paper examines the ways in which neoliberal responses to social health
issues shape the educational discourses and practices of schools. As schools
are increasingly identified as ideal spaces for health promotion, the question
of how and why educators and public health practitioners can and should work
together continues to be debated. Using Bourdieu’s theory of reproduction, we
use this indicative example of emergency food to examine how ‘charity alone’
models reproduce and perpetuate inequitable health outcomes in neoliberal
societies. This individualistic view of health continues to work against public
health and social justice education initiatives increasingly found in schools,
curricula and wider society; creating a dissonance between rhetoric and
reality. Revolutionary critical pedagogies are explored to examine the
implications of these practices in schools, and how the framework of service
learning may offer an approach for involving primary students in empathy,
caring and social justice. We seek to extend the existing literature by
exploring ways of shifting, rather than reproducing, the current practices of
educators and public health practitioners in how children experience health
inequality and the social determinants of health.

11 March 2016

Many
thanks to all those who joined the conversation, prepared submissions and
contributed to the Network’s submission (final posted below (19 Feb) on the
Healthy Tasmania Community Consultation Draft. Some of us also attended the public forums
that were held and it was fantastic to hear a strong voice on the need for
action on the social determinants of health. It’s important that we continue to
advocate at all levels in relation to this matter.

To
help us plan our next moves as a Network please join us for our next
meeting on 29th
of April(10 – 11 am)- all
welcome. Attend and video conference at these sites: Hobart, Launceston & Burnie. Please RSVP and obtain further details by contacting: socialdeterminantsofhealthtas@gmail.com.

Information
and resources:

Climate Change and Health Promotion

This
virtual issue of Health Promotion Journal of Australia devoted to climate
change is timely and important. The recent Paris Agreement in which the world’s
nations committed to try to limit global warming to 1.5°C above pre-industrial
temperatures will mean our efforts to transform into low carbon societies and
economies over next few decades will be both dramatic and disruptive. The
nature and scale of disruption will depend on the extent to which industries,
sectors, businesses and professions prepare for and are involved in this 21st
century low carbon ‘revolution’. Read more: http://www.publish.csiro.au/nid/293/aid/20759.htm

19 February 2016

19 February 2016

A
Healthy Tasmania

Department
of Health and Human Services

GPO
Box 125

Hobart
TAS 7001

Submission on the Healthy Tasmania Community
Consultation Draft

The
Tasmanian Social Determinants of Health Advocacy Network (SDoHAN) appreciates
this opportunity to comment on the Community Consultation Draft of the Healthy
Tasmania Five Year Strategic Plan (December 2015). We commend the Tasmanian
Government for taking this important step towards a healthier Tasmania.

As a
Network, we support the goal of improving the health of the Tasmanian
population through systems change and investment in preventive measures
underpinned by evidence-informed action on the social determinants of health. We
endorse the World Health Organisation’s definition of health as “a state of complete
physical, mental and social well-being and not merely the absence of disease or
infirmity. Therefore, it focuses not only on reducing mortality and morbidity,
but on the impact of health determinants, the economic, environmental and
social conditions, on health and well-being at various stages in life.”[i]

To
improve the effectiveness of the planned strategy we strongly suggest that the
following elements are incorporated.

A core focus on the social
determinants of health.
The Consultation Draft makes minimal reference to social and environmental factors
such as education, income, housing, food security, equity, climate change and
social connections, and the influence these have on health outcomes. Tasmania continues to have among the lowest
health status in Australia yet is spending as much if not more on health
services than are other states and territories. Clearly, continual investment
in services is having little effect on the overall health of the population and
there are many other reasons that lie much deeper than our health care system
for our low achievements in health. The proposed health impact assessment
process has the potential to recognise social factors and their effect on
population health, but this process is complex, and must be well-resourced to
do so. The planned commissioning model should also be strongly based within a
social determinants framework.

There
is a strong international evidence base which clearly demonstrates the
relationship between action on social determinants and improved health outcomes
(e.g. Closing the gap in a generation:
Health equity through action on the social determinants of health (WHO,
2008); Evidence review: Early childhood
development and the social determinants of health inequities (Moore et al
2015); Addressing the Social Determinants
of Health to Reduce Tobacco-Related Disparities (Garrett et al 2015); Social Determinants of Mental Health
(WHO, 2014); Health equity in Australia:
A policy framework based on action on the social determinants of obesity,
alcohol and tobacco (Friel, 2009).

In
our submission to the Joint Select
Committee Preventative Health Care Inquiry, we provided numerous examples
of evidence of some of the social determinants on health in the Tasmanian
context. On this note, we urge the Government, in preparing the Healthy
Tasmania Five Year Strategic Plan to consider the submissions that were
presented by stakeholders to this Inquiry and to engage in dialogue with the
Committee as it prepares its report. The two pieces of work should be in
synergy and the evidence that was presented to the Inquiry taken into consideration
as part of the development process for the Government’s Strategic Plan.

The
action areas of the Ottawa Charter for Health Promotion
(WHO, 1986) that include:

obuilding healthy public policy

ocreating supportive environments

ostrengthening community action

odeveloping personal skills

oreorienting health services.

Focusing simply on education strategies and placing the responsibility for improving one’s health on the individual, without appreciation for the wider determinants of health and a comprehensive plan of actions, is out of step with modern thinking and evidence-based best practice.

The concept
of Proportional Universalism. We encourage the Government to become familiar with
the concept of proportionate universalism
and to embrace a population health approach. Proportionate universalism is the resourcing and
delivering of universal services and programs at a scale and intensity
proportionate to the degree of need.[ii]
We would argue that the terms preventive, public, and population health should
not be used interchangeably. Public health (the ‘new’ definition) and
population health are about more than prevention. A comprehensive review of the
literature would be useful in clarifying any misconception and provide the Government
with a useful framework.

A
life course approach. Government’s
Strategic Plan should emphasis a life course approach to good health and
wellbeing. Key stages in people’s lives have particular relevance for their
health. The life course approach is about recognising the importance of these
stages. The Strategic Plan should respond to key milestones in the life course
including the early years, adolescence, work/social life, and ageing. Each of
these phases presents important opportunities for a healthy life.

Building on relevant
literature. The
Consultation Draft needs to draw strong parallels with existing well-researched
publications, frameworks and plans, such as Chronic
diseases in Australia: Blueprint for preventive action, The Cost of Inaction on
the Social Determinants of Health, Rethink
Mental Health (obesity and smoking should not be considered in isolation of
mental health and wellbeing, and other social determinants such as employment
and income) and The World Report on Ageing
and Health. We note that there is virtually no reference to Tasmania’s five-yearly
State of Public Health Report (a requirement of the Public Health Act 1997) or
to relevant preventative health data that demonstrates social gradients of health
in Tasmania. We suggest that further research be undertaken to
inform the Strategic Plan and that it be prepared in consultation with those who
can identify the existing evidence-base on which it should be based.

We encourage the Government
to recognise frameworks and principles such as those put forward in Chronic diseases in Australia: Blueprint for
preventive action, and to base the Plan on a similar set of principles:

1.
Systemic approach: focus on common
risk factors and determinants, not individual diseases.

2.
Evidence-based action: act now using
best available evidence and continue to build evidence.

3.
Tackling health inequity: work to
improve and redress inequities in outcomes.

4.
National agenda with local action:
build commitment and innovation with local action.

5.
A life course approach: intervene
early and exploit prevention opportunities at all ages and across generations.

Addressing legal barriers. Legal barriers that undermine health and wellbeing outcomes for Tasmanian’s must be addressed if there is to be successful implementation of harm reduction and health promotion programs in the community. Punitive laws, policies and practices that promote stigma and discrimination against particular groups in the community (such as sex workers, people living with or affected by HIV, people who inject drugs) persist within many healthcare facilities, deterring people from seeking services, eroding trust in health systems and jeopardising implementation of and access to services. An investment approach that strengthens linkages to the Office of the Attorney General should be adopted as part of a Health in All Policies approach.

Achieving good health requires significant investment. We question what new money will be directed towards improving the health of the population. We note that current investment in preventive health is just 1.9% of the Department’s budget and dispute the statement that the “Tasmanian Government already significantly invests in prevention...” While we support ideas raised in the Consultation Draft such as health impact assessment, embedding a focus on health across government, improving health literacy and anticipatory care, these are all processes that require significant planning and investment. We thus endorse the proposal by the Heart Foundation, TasCOSS and others that the prevention budget be raised to at least 5% of the health budget (irrespective of where this money comes from).

Ongoing community consultation. We encourage the Government to include the communitywhen preparing its Healthy Tasmania Five Year Strategic Plan – recognising communities as educators of policy-makers.[iv]We query what process the Government employed in determining the priorities identified in the discussion paper. We agree that obesity, smoking and health literacy are issues of concern but such symptoms are usually the result of more complex social problems – and this is not reflected in your Consultation Draft.

When consulting with the community, there needs to be acknowledgement that health is complicated and that language matters. As stated by World Health Organisation: “Health is not a stand-alone phenomenon with clear boundaries. Diseases and health conditions have multiple causes, including social. They are interrelated with nature and nurture, and evolve over time.”[v]This complexity is well recognised in the community. In 2015, we undertook a study where we asked members of the Tasmanian public for their thoughts about health, and specifically the way in which policy makers and researchers talk about it. In contrast to the Healthy Tasmania publication, we found that Tasmanians place a lot of emphasis on the underlying factors that contribute to good health – such as education, housing, and social connections.

We also found that the community are concerned when they are labelled as being ‘vulnerable’, ‘disadvantaged’ and being ‘targeted’. Study participants described these words as being impersonal and vilifying, contributing to stigma and blame. Participants suggested that words which reflect prejudice, that oversimplify complex relationships or that minimise history, can heighten bias and exclusion. Study participants suggested that those who use such terminology are disconnected and out of touch.

If we want to be a healthy population, we need to bring everyone along for the ride. Defining people by their weaknesses and over-simplifying the complexities of their existence will not lead us to the end goal.

Ongoing community partnerships. We strongly urge the Government to work in partnership with stakeholders – such as community organisations, peak bodies and volunteer networks – to determine the health priorities that can make Tasmanians a healthier population. There is vast untapped knowledge and important social capital that could support the Government’s work in this area. Tapping into this knowledge, and integrating it with quality data will help give the Government a strong evidence-based Strategic Plan.

Achieving good health requires a long term approach. We wish to raise the point that if the Government is serious about improving the health of the population, a five year timeframe is too short. This is a plan that requires long term strategic vision, with bi-partisan support. It also requires a Health in All Policies approach. As it stands, the Consultation Draft proffers much uncertainty in terms of:

·The governance arrangements for the implementation of the Strategic Plan; how will the Government ensure accountability, transparency and inclusiveness in governance?

·The resources that will be invested in the implementation and evaluation of the Strategic Plan.

We look forward to further engagement as the Government undertakes the process of developing the Healthy Tasmania Five Year Strategic Plan.

[i]
WHO, Health at key stages of life – the
life-course approach to public health, WHO, Denmark.

The Social Determinants of Health Advocacy Network held its inaugural conference in Hobart last November

Visit our website to view and download some of the presentations

Visit: http://sdohtasmania.org.au

.

What are the social determinants of health?

The word social relates to society and means people.

Determinants of health are - broadly speaking - the things that affect your health - either in a positive way (they protect our health and keep us healthy) or a negative way (they make us sick).

If we put these things together - the social determinants of health are things (systems, products, factors) created, shaped and controlled by people that affect our health.

These things include education, housing, employment, transport and so forth. These are created and shaped by people. And because if this it's possible to change them.

As an example, let's look at transport. We - the people - have created our transport systems. Not necessarily you or I personally but as a society we've done this. The problem is that there are many aspects of the system that are not great - many of our streets aren't cycle or pedestrian friendly, if you live in a rural area public transport options are limited, the number of cars on our roads isn't good for the environment and so forth. All of these things about the transport system can affect our health.

But the great thing is that, because we - the people - developed this system in the first place, we have the ability to change it - to make things better and to improve health as a result.

There are other determinants of health - such as our genes - that we can't change. So let's focus on the things we can do to improve health.

More formally, here's how the literature talks about the social determinants of health:

The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.

Here's a good place to start your reading:

A great publication on the social determinants of health is The Solid Facts.

Vision of the Network

All Tasmanians have the opportunity to live a long, healthy life regardless of their income, education, employment, gender, sexuality, capabilities, cultural background, who they are or where they live.

Membership

Membership of the Network is open to all Tasmanians who share this vision.

Membership is free of charge. Membership means you become a subscriber to our enews and that you get the opportunity to work with others who are part of this Network to undertake advocacy action.

Membership to the Network can be obtained by providing a name, organisation (where there is one but individuals can join as individuals), address, telephone and email address to the Facilitator by email:

socialdeterminantsofhealthtas@gmail.com

The Network currently has more than 220 members across Tasmania (as well as some interstate) from a broad range of sectors.

“The Commission’s main finding is straightforward. The social conditions in which people are born, live, and work are the single most important determinant of good health or ill health, of a long and productive life, or a short and miserable one. ……..This ends the debate decisively. Health care is an important determinant of health. Lifestyles are important determinants of health. ….But, let me emphasize, it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place”.

Dr Margaret Chan, Director General, World Health Organisation.

Tasmanian Action Sheets on the Social Determinants of Health

Visit the Tasmania Council of Social Service website to download 10 action sheets on the social determinants of health in Tasmania.